The Strong Heart Study, a study of cardiovascular disease (CVD) among American Indians, involves 13 Indian communities in Arizona, Oklahoma and North and South Dakota. Phase I, which began on October 1, 1988 included a medical record review to determine mortality and morbidity for CVD in individuals age 45 to 74 years between 1984 and 1988. In addition, a physical examination was performed on individuals 45 to 74 years old to measure prevalence of cardiovascular and peripheral vascular disease, and known and suspected risk factors. Follow up exams (Phase II) were conducted from 1993-95. This application proposes an extension (Phase III) of the Strong Heart Study in which the community mortality survey will be continued, and the cohort of men and women examined during Phase I will be followed and re-examined. The aims of Phase III are to determine CVD mortality and morbidity rates in the cohort and to determine their CVD risk factors, the changes in risk factors over time, and the relationships between risk factors and CVD. Additional aims are to compare changes in CVD risk factors at the three centers, to relate them to differences in the rates of CVD, to assess and compare risk factors for CVD among diabetic and non-diabetic individuals, to investigate atherosclerosis by performing carotid artery ultrasounds and to study genetic determinants of CVD.